Peach State Health Plan prior authorization, page 90

CPT code lookup

Each row is one code from the public prior authorization list. The description is the procedure or service name on that source row. This is not a coverage decision.

Prior authorization codes

Prior authorization codes
Code	Description	Source
92284	General Eye Exams & Diagnostics	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92285	General Eye Exams & Diagnostics	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92286	General Eye Exams & Diagnostics	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92287	General Eye Exams & Diagnostics	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
G0117	General Eye Exams & Diagnostics	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
G0118	General Eye Exams & Diagnostics	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
S0620	General Eye Exams & Diagnostics	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
S0621	General Eye Exams & Diagnostics	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
S3000	General Eye Exams & Diagnostics	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
0100T	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
0660T	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
0661T	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
0671T	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
0730T	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
0810T	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
65710	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
65730	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
65750	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
65755	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
65756	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
65767	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
65771	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
65780	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
65781	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
65782	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
67299	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
67399	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
67599	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
68399	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
68841	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
68899	Glaucoma & Eyeball Procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
66989	Lens and cataract procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
66991	Lens and cataract procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
66999	Lens and cataract procedures	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92310	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92311	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92312	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92313	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92314	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92315	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92316	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92317	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92325	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92326	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92340	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92341	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92342	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92352	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92353	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy
92354	Visual aids and other optical supplies	CMS Final Rule 0057-F Prior Authorization Requirements, Pg 16 Original policy

Sources

CMS Final Rule 0057-F Prior Authorization Requirements